English 
Italian CASI CLINICI – Case Reports
Volume:
Biochimica Clinica 2018; 42(1) e08-e011
Published on-line:
February 2, 2018
DOI:
10.19186/BC_2018.009
Una diagnosi in laboratorio
AUTHORS
1Laboratorio Analisi Chimico Cliniche e Microbiologia e 2Laboratorio Ematologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano
ABSTRACT
A case of atypical celiac disease with hematological involvement
We report a case of a pregnant 39 year-old woman (22th week) with leuco-granulocitopenia, iron-deficiency anemia and a slight elevation of transaminases, lasting for several years. The origin of these biochemical alterations was unclear. Assuming a possible autoimmune condition, she underwent a hematological counselling in order to verify the presence of an immunological disorder. Anti-nuclear antibodies resulted negative with a citoplasmic filamentous fluorescence suggestive of anti-smooth muscle antibodies (ASMA). On a suitable substrate for ASMA detection, a reticulin-like fluorescence was observed, inducing to investigate for the presence of celiac disease (CD). CD diagnosis requires both the biochemical tests and duodenal biopsy; however, because of the pregnancy only the serum panel was performed (serum IgA, anti-tissue transglutaminase IgA, anti-endomisium IgA). As the tests were all positive, clinicians decided to start the gluten free diet with an improvement of the hematological and biochemical parameters. The patient gave birth to a healthy newborn.